Risk Stratification

Healthcare Analytics

Caradigm delivers the business and clinical intelligence to generate insights and drive better decisions.


As more healthcare organizations participate in value-based reimbursement models, they have an increased responsibility to report on and improve quality measures. To support population health, your organization needs analytics that deliver retrospective review, ongoing surveillance and predictive modeling.

  •    Retrospective review delivers performance and activity reporting – including patient attribution utilization,    variation in care, and total cost of care
  •    Current or near real-time reporting supports care management, identifying gaps in care and alerting physicians    and patients for care planning from a population view
  •    With risk stratification and predictive modeling, you can classify patients by health risk to deliver cost-effective     interventions and predict and prevent readmissions.


Caradigm offers a number of analytics solutions designed to identify the insights within the complexity of healthcare. Caradigm’s offerings include solutions that report retrospective activity, monitor current activity and predict future activity, as well as provide the tools for root-cause analysis.

Caradigm analytics solutions like Risk Stratification are designed to provide deep insight into patients, populations, processes and performance, helping health systems understand risk and the actions needed for effective population health management.

In order to deliver high-quality care and manage utilization and costs, healthcare delivery organizations need to better understand the population. A relatively small set of high-cost, high-utilization patients can generate disproportionately high patients/members and succeed under changing reimbursement models. Caradigm Risk Stratification enables healthcare delivery organizations to identify patients that would benefit from care management or patient campaigns.

High-quality care delivery and utilization, and costs management requires access to a multitude of indicators describing patients so that the effect of change in their patient population can be understood. Caradigm Risk Stratification allows you to surface data from multiple sources to provide segmented patient lists that include clinical indicators and, risk scores to identify patients at risk. Streamlining patient enrollment into applicable campaigns and programs helps patients engage more quickly and have appropriate resources directed to patients with the highest potential for improved outcomes and lowered costs. Caradigm Risk Stratification integrates Caradigm Care Management to provide a seamless workflow from stratification of patient population to care coordination program enrollment.

Business Analyst Focus

  •    Stratification of patient populations using multi-factor risk analysis to identify characteristics driving risk and cost
  •    Direct referral of patients or populations from risk stratification lists to care management workflows through    tightly integrated referral pathways, such as auto-generation of enrollment tasks
  •    Direct link from a Stratification List to an individual patient’s record

Organization Focus

  •    Get started with claims files, such as the CCLF, to have sufficient data to start creating lists
  •    Create new lists, or augment existing lists, with clinical, financial and social indicators
  •    Ingest real-time clinical and/or claims data to compute multi-factor risk indicators for the population
  •    Access the rich, underlying Caradigm Intelligence Platform (CIP) data asset that is updated in real-time as feed    information is sent into the system
  •    View risk indicators calculated real-time as data is ingested, to enable analysts to more quickly detect patient rising    risk levels
  •    Plug in third party risk stratification and predictive risk models


Milliman MARA

Caradigm Risk Stratification integrates with Milliman MARA to deliver predictive modeling of risk within a Medicare population.

Milliman Advanced Risk Adjusters (MARA) is a suite of risk adjustment tools with a variety of predictive modeling applications for the health insurance industry.

MARA was developed by leading actuaries, clinicians, and healthcare business experts at Milliman, Inc. The MARA models offer a significant advancement over traditional risk “groupers,” risk assessment tools, or predictive models. These advancements are the result of years of healthcare analysis and the application of more sophisticated methods of building predictions. Using longitudinal observations of medical conditions and a proprietary set of conditions, MARA developers have created models that outperform others. MARA’s algorithms produce superior results and more useful output.

Social Determinants of Health

Caradigm Risk Stratification incorporates social determinants of health in the identification of patients that would benefit from care management or patient outreach. Risk Stratification allows for population stratification based on social factors such as food access, transportation access, home stability, financial stability and health literacy that contribute to the overall picture of a patient’s health. Further, Risk Stratification allows for stratification based on predictive risk factors (i.e., readmissions risk, no-show risk and med adherence risk) that are based on clinical and social factors.

Social determinants of health account for approximately 50 percent of overall patient health and include education, job status, social support, income and community safety. Patients that have socioeconomic or environmental challenges are less likely to have the ability to cope when physical health issues arise. Therefore, having insight into the social determinant factors impacting a patient population can help healthcare organizations better identify patients at-risk and assist in dealing with these issues that can have an extraordinary impact on cost, quality and adherence to the plan of care.


How it works



Key Features

  •    Rich underlying data asset, updated in real time
  •    Out of the box conditions lists to initiate risk identification activities
  •    Sorting and filtering on Chronic Comorbidity and other clinical factors associated with chronic conditions
  •    Tightly integrated referral pathway into Caradigm Care Management workflows with bulk generation (manual or    automated) of enrollment tasks
  •    Real-time updates of risk indicators as data is ingested to detect patient rising risk levels
  •    Extensibility and configurability to create new lists or augment existing lists
  •    Ability to plug in third party risk-stratification models
  •    Drill-down from a registry to see an individual patient’s record


Key Benefits

  •    Stratification of patient population using clinical, financial, behavioral and social indicators
  •    Better management of high risk and potentially high-cost populations
  •    Identification of proactive opportunities for utilization improvement
  •    Streamlined enrollment to care management programs
  •    Ability to evolve registries to include additional indicators of risk (e.g. financial, social and behavioral)